Surgery for Gastrointestinal Stromal Tumors

Surgery is usually the main treatment for gastrointestinal stromal tumors (GISTs) that haven’t spread. The goal of the surgery is to remove all of the cancer.

The type of surgery needed depends on the location and size of the tumor.

Surgery for small GISTs

If the tumor is small, it often can be removed along with a small area of normal tissue around it. This is done through a cut (incision) in the skin. Unlike many other cancers, GISTs almost never spread to the lymph nodes, so removing nearby lymph nodes is usually not needed.

For some small cancers, “keyhole” (laparoscopic) surgery is an option. Instead of making a large incision in the skin to remove the tumor, several small ones are used. The surgeon inserts a thin, lighted tube with a tiny video camera on the end (a laparoscope) through one of them. This lets them see inside the belly. Long, thin surgical tools are then used through the other incisions to remove the tumor. Because the incisions are small, patients usually recover more quickly from this type of surgery than from traditional surgery that requires a longer incision.

Surgery for larger GISTs

If the tumor is large or growing into other organs, the surgeon might still be able to remove it entirely. To do this, parts of organs (such as a section of the intestines) might need to be removed. The surgeon might also remove tumors that have spread elsewhere in the abdomen, such as the liver.

Another option for tumors that are large or have grown into nearby areas might be to take the targeted drug imatinib (Gleevec) first, typically for at least several months. This is called neoadjuvant treatment and can often shrink the tumor, making it easier to remove with surgery.

Surgery for metastatic GISTs

Surgery is not a common treatment for a GIST that has spread (metastasized) to other parts of the body. Targeted therapy drugs are usually the first option for metastatic GISTs. But if there are no more than a few metastatic tumors and they respond well to targeted therapy, some doctors might advise surgery to remove them. No large studies have been done to show how helpful this is, but it might be an option. If your doctor offers this surgery, be sure you understand the goals and possible side effects.

If the tumors are in the liver and would be hard to remove, other options might include different types of local treatments, such as ablation or embolization.

Choosing your surgeon

No matter what type of surgery is done, it's very important that it is done by a surgeon experienced in treating GISTs. GISTs are often delicate tumors, and surgeons must be careful not to open the outer lining that surrounds them (known as the capsule), because it might increase the risk of spreading the cancer. GISTs also tend to have a lot of blood vessels, so your surgeon has to be careful to control any bleeding from the tumor.

For more information about finding a surgeon, see Where to Find Cancer Care.